Coffee CAR-T.

Jumpstart your morning with a refresher on the short history and rapid market entries of chimeric antigen receptor T-cell (CAR-T cell) therapies. As a reminder, Kymriah was approved in August for second-refractory acute lymphoblastic leukemia (ALL) in patients 25 years and younger. This was soon followed by Yescarta’s approval in October for second-refractory diffuse large B-cell lymphoma (DLBCL). Both treatments involve taking patients’ own T-cells and genetically modifying them ex vivo to express a universal receptor for the CD19 antigen present on most malignant (and normal) B-cells. Side note: luckily, losing normal B-cells is an acceptable toxicity--as opposed to losing most other normal cells en masse--due to hematologic cell-lines’ ready-regeneration. The biggest clinical downside: a 25% rate of inducing a cytokine storm that can all too easily lead to grade 5 neurotoxicity. What’s more, there are the major logistical challenges of mega-costs, a prescription to cell-delivery turnaround time of a few weeks, and a less-than-desirable rate of durable responses. Nonetheless, we suggest you sip on the data surrounding this exciting new brew of immunotherapy because CAR-T cells are coming to a heme-onc unit near you.